A North Korean defector was recently found with anthrax antibodies in his blood which has caused quite the stir, particularly among South Koreans and U.S. forces in South Korea.

There has been some confusion as to what this could mean. Why would someone have anthrax antibodies in his bloodstream? How is that indicative of some kind of weaponized anthrax? This article will discuss several of the more prominent possibilities.

But first: what are antibodies? Long story short, antibodies are small proteins that your body can make to neutralize diseases. You can develop antibodies through vaccinations or exposure to the biological agent (naturally occurring or weaponized) in question.

It’s important to realize that, with a thorough medical history and physical exam, health professionals would be able to determine the method of exposure to the defector. Here are four of the conclusions they may have come to:

Possibility 1: Modern anthrax vaccinations

Anthrax vaccinations take a strict regimen/series of shots into the muscle to work. It’s six doses at 0, 2, 4 weeks and 6, 12, 18 months consecutively, and missing a dose potentially makes the vaccine less effective. On top of this, once you’re done with the vaccine, you need boosters to keep it up. While there are newer systems emerging that allow for five shots instead of six, this is the type of system necessary to develop an effective vaccine to combat weaponized anthrax.

The task of getting immunizations out is usually passed down to medics or other on-site medical personnel. They have their list of names and they track down soldiers to make sure they have their latest shots. Soldiers certainly cannot be relied upon across the board to make all of these appointments themselves — while many would do it, many forget or don’t take it seriously. This is a problem in the U.S. military, and so it is possible that it would be a problem in the North Korean military as well.

All of this means that, in order to effectively vaccinate a military population against anthrax, you need to have some level of infrastructure to back that up. This while ignoring the difficulties in developing, manufacturing, storing/refrigerating and distributing the vaccines in the first place. Given North Korea’s limited resources, an effort like this would require a significant reason.

Those reasons could be classified into defensive or offensive motives. It is possible that Kim Jong Un’s regime is devoting all of these substantial resources in producing vaccines purely out of paranoia of a U.S. biological offensive. The U.S. accidentally shipped anthrax to a U.S. base in South Korea in 2015 — the incident had zero casualties, but it is plausible that this incident and other talks of biological weapons could have spurred rumors throughout the paranoid administration. Any reasonable person however, must know that the U.S. would not use weaponized anthrax. Besides the immeasurable ethical and legal reasons, they simply have better tools. Biological weapons are unpredictable and can easily infect friendlies as well as the enemy. So it stands to reason that, if an anthrax vaccination program is in place in the North Korean military, then they are vaccinating their soldiers in order to minimize their own casualties if they decide to use the weapon. Under this theory, it certainly follows that they must have developed or are developing biological weapons.

Possibility 2: Low-tech vaccinations

There are ways to produce antibodies to help fight anthrax without developing the ultra-complex system of vaccinations we have in the United States today. The first smallpox vaccine from 1796 wasn’t exactly built from state-of-the-art, 21st century technology — it was done by scratching live cowpox virus onto a young boy’s arm and hoping it worked. It did.

Someone could build antibodies by utilizing a similar method with cutaneous anthrax. With antibiotics, cutaneous anthrax kills less than 1% of its victims. This might not be an acceptable rate for medicine in many countries, but for North Korea? Maybe they’re willing to lose a small percentage in order to vaccinate themselves for either a weapon they are developing or out of the paranoid idea that anthrax might be used against them.

Possibility 3: Incidental exposure to weaponized anthrax

If the North Korean defector was exposed to weaponized anthrax, there are several ways this could have happened. As mentioned before, the resources and infrastructure of North Korea are limited, so leaks or outbreaks near research/development facilities are plausible (though the exact nature of such facilities remains unknown). Either way, much depends on the method of exposure.

If he inhaled it: Treatment requires antibiotics. The early stage of inhalation of anthrax (what they would most likely use for weapons) looks like the flu, and if it goes untreated by the time you realize it’s NOT the flu, it’s pretty much too late — death is usually inevitable. However, if there was a leak or an outbreak, North Korean authorities could automatically distribute antibiotics to anyone with flu-like symptoms, nipping it in the butt and no one would ever be the wiser.

The overall fatality rate of inhalation anthrax has historically been quite devastating, averaging approximately 92% (not including the attacks on New York).

If he touched it: The defector may also have been exposed to anthrax cutaneously (via the skin), again perhaps through mishandling, leaks or just someone walking out with a bit on their jacket. While weaponized anthrax is generally designed to be inhaled, it also spreads quite easily physically, and so the defector may not have had direct contact with the production process himself.

If untreated, approximately 20% of people with cutaneous anthrax die. Treated with antibiotics, that number goes below 1%. Again, it’s possible that North Korean authorities stifled the outbreak with antibiotics before it spread too far and most people never even knew they had anything beyond the flu; it’s also possible that they did nothing and the infected assumed the 20% death rate in that area was some obscure sickness, attributing it to the general health crisis already permeating North Korea.

It’s important to realize that they would not have to distribute the antibiotics out of the goodness of their hearts, it could have been done to keep their biological weapons research a secret. It’s also important to understand the reclusive nature of North Korea and that it would be within their capabilities to contain a small outbreak from the media.

Possibility 4: Exposure to naturally occurring anthrax

This one is unlikely given the current state of affairs in North Korea, but it is technically still possible. Anthrax does occur in nature, and it is more prevalent in poorer areas but given the political climate and the tensions in North Korea, this would be a pretty significant coincidence.

According to The National Center for Biotechnology Information (NCBI), information on naturally occurring anthrax in North Korea is unknown, but “sporadic outbreaks” have occurred in South Korea just next door and in northern Russia. As mentioned previously, cutaneous anthrax can produce antibodies without necessarily killing the patient.

As it occurs naturally, you get the various types of anthrax — inhalation, cutaneous and gastrointestinal — and they present themselves in various ways. You can get it from working around animals, from spores in the ground or from eating contaminated meat that hasn’t been fully cooked. The less preventative infrastructure (detection efforts, vaccinations for animals, basic healthcare and hygiene, lack of vaccinations for humans) the more likely these incidents are to happen. For example, with the food crisis in North Korea, some people may be more inclined to cook meat they found that has been dead for an unknown period of time, simply because they are starving. With limited resources to cook with, gastrointestinal anthrax could be a possibility.

While a natural occurrence in this case is unlikely, the medical professionals charged with investigating the origins of the defector’s anthrax antibodies will undoubtedly make attempts to try to definitively rule out naturally occurring anthrax. It’s worth noting, anthrax spores can lay dormant for decades underground, so it’s possible he got it from digging one of those tunnels.

Featured image courtesy of the Associated Press.